Currently little is known of postpartum depression (PPD) screening and referral for refugee and immigrant women in Northern New England where the foreign born population has been rapidly expanding in the past decade. Research on PPD has focused largely on the general population leaving a large gap in our understanding of PPD in this vulnerable group. A retrospective chart review was conducted from a tertiary medical center with 1,160 births per year. Total sample n = 126, 28 % scored at risk for PPD. 39 % of women at risk had follow up documented as a phone call alone, however 43 % of that at risk group did not speak English. Focuses on the suitability of tools that have not been psychometrically tested for this population and may be culturally inappropriate for non western women. Lack of appropriate follow up is challenged and who is best placed to perform screening is considered.